When viewed from the side, the spine features natural curves that form an “S”-like shape, with curves that bend forward in the cervical (neck) spine and the lumbar (low back) spine and bend backward in the thoracic (middle back) spine. Kyphosis is a type of abnormal curve in which the normal curve of the thoracic spine becomes exaggerated. This results in the appearance of a hump or a hunched back. Kyphosis varies in severity, from minor changes in the shape of the back to severe deformity, nerve problems, and chronic pain. Kyphosis most commonly occurs in the thoracic spine, though it can also affect the cervical or lumbar spine. It most commonly presents during adolescence but may also present during adulthood.
Symptoms of kyphosis include unattractive posture, pain, and/or severe pressure on the lungs and abdomen. The pain primarily affects the area of the kyphosis. Severe curvature can also put pressure on the spinal cord and nerve roots, which may cause weakness in the lower extremities. Eventually, kyphotic pressure on the lungs and abdomen may affect breathing and appetite.
The most common type of Kyphosis, “Scheuermann’s disease”, presents during adolescence. Its cause is unknown but may be related to a growth disturbance. Several different factors can cause kyphosis in adults. The most common cause is osteoporosis, a condition that leads to losses of bone mass, leaving the bones brittle and prone to fractures. Kyphosis can also be congenital (present from birth). The deformity can also be traumatic, the result of an injury to the spine. Finally, kyphosis may result from iatrogenic causes (medical treatment or surgery).
A physician can diagnosis kyphosis based on appearance of the physical deformity, aching back pain, or increased lumbar lordosis (the normal forward curve of the low back). If kyphosis is suspected, your doctor will evaluate your family history and your own history–when you first noticed the problem and how it has changed. The doctor will also need to know about any other pain, bowel or bladder dysfunction, or motor function. In addition to a physical exam, the doctor will likely order X-rays. Other tests may be ordered to look at specific aspects of the spine, including an MRI, a CT scan or special nerve tests to determine if any nerves are being irritated or pinched.
At one time, body casts were the only method used to treat adult kyphosis. Fortunately, better treatment methods have evolved over time. Today, numerous effective options are available to correct a severe kyphotic deformity.
The first step may include medications, exercise, and special braces to support the spine. These braces may provide some pain relief, but do not actually straighten the spine in adults. Physical therapy may also be an option.
If osteoporosis is present, treating it may also slow the progression or reduce symptoms from the kyphosis. Osteoporosis treatment usually involves increasing calcium and vitamin D intake, hormone replacement therapy, and weight-bearing exercises.
For patients with severe pain, a progressively worsening curve, or damage to the spinal cord, surgery is recommended. For some patients with Kyphosis, their appearance has resulted in significant psychological issues. Surgery is the only technique to correct the deformity. If the deformity is identified during growth and the curve is small then a brace may be helpful to prevent curve progression. Surgery may provide the best correction for cosmetic purposes as well. Surgical treatment options for kyphosis include kyphoplasty and spinal fusion, with or without surgical instrumentation. Since each case of kyphosis is somewhat different, your doctor will choose the specific technique that will best straighten your spine and solve any other problems associated with your kyphosis.